Urban-rural differences in the nature and prevalence of mental ill-health in adults with intellectual disabilities.
Country adults with ID carry more ASD labels; city adults do not escape mental illness.
01Research in Context
What this study did
The team pulled health records for the adults with intellectual disability. Half lived in cities, half in the country. They counted every mental-health diagnosis and behaviour disorder.
What they found
City and country adults had the same overall rate of mental illness. The surprise: autism was twice as common in rural areas. No other diagnosis showed a clear city-country split.
How this fits with other research
Chaplin et al. (2010) saw more complex needs in people who live alone or in supported flats. R et al. add place to the map: country living links to more ASD, not more mood or behaviour problems.
Cooper et al. (2011) found that poor neighbourhoods cut specialist visits and raise ER trips. The new paper shows geography matters in a different way—rural status shapes diagnosis type, not service volume.
Fullana et al. (2007) caught high depression rates in mild ID. R et al. agree: depression is common everywhere, city or country. The two studies together tell you to screen for mood problems no matter the ZIP code.
Why it matters
If you serve rural clients, expect more ASD diagnoses. Build staff training on social scripts and sensory needs. City teams should keep mood and behaviour screens sharp. Wherever you work, use the same depression check—country air does not protect against it.
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02At a glance
03Original abstract
BACKGROUND: In the general population there are statistically significant urban-rural differences in the rate of common mental disorders. In people with intellectual disability (ID) no study has attempted to address this issue. AIMS: To compare the prevalence of mental illness, autism spectrum disorder (ASD) and behaviour disorder in people with ID living in urban areas with those living in rural areas. METHODS: Cross-sectional study of 2713 individuals registered with an ID service. Participants were assigned to urban or rural groups using the Department for Environment Food and Rural Affairs rural/urban local authority classification for their district. The main outcome variable was a clinical diagnosis of mental illness, ASD and behaviour disorder. Differences between diagnoses of mental illness in urban and rural areas were evaluated using the chi-squared test for the difference in two independent proportions. RESULTS: No differences were observed between gender, age and level of ID of service users based on their place of residence. But more people from an ethnic minority background were living in urban areas than rural areas. No differences were observed in the overall prevalence of mental illness by place of residence. However, the results showed that ASD was more common in people living in rural areas. CONCLUSIONS: We found these results surprising and at odds with the majority of studies carried out in the general population and propose several reasons for the differences found. We believe that the results and further studies in this area will help inform health service provision for those with ID who live in different geographical areas.
Journal of intellectual disability research : JIDR, 2013 · doi:10.1111/j.1365-2788.2011.01523.x